Doctor warns of cavalier attitude’ toward Botox procedures

There may be no better publicity for caution than the swollen, misshapen face of 62-year-old Priscilla Presley, which more than 20 million people saw during her five weeks on “Dancing with the Stars.”

Jody Feinberg

There may be no better publicity for caution than the face of 62-year-old Priscilla Presley, which more than 20 million people saw during her five weeks as a contestant on “Dancing with the Stars.”

Her swollen, misshapen face had nothing to do with her contest elimination. Rather, it was evidence of a botched cosmetic procedure. At a Hollywood party in 2003, Presley received an injection of a substance that was not approved by the Food & Drug Administration, from a physician unlicensed to practice in the United States.

While rare, Presley’s plight highlights the potential dangers of non-surgical cosmetic procedures to reduce wrinkles and lines, such as Botox and Myobloc, made from botulinum toxin, and Juvederm and Restylane, made from hyaluronic acid.

“I do think there is in some cases a cavalier attitude with the increased popularity of these procedures and the Botox parties,” said Dr. Stephen Delia, a plastic surgeon who runs the Bay State Center for Plastic Surgery in Stoughton and Duxbury. “I would never get Botox at a salon or a party. I would get it in a physician’s office from a doctor who had a lot of experience with it.”

When Presley was injected, she received low-grade industrial silicone, from Dr. Daniel Serrano, who claimed it was “better than Botox.” An Argentine, Serrano recently was released from prison after serving time for drug smuggling and conspiracy to use unapproved drugs.

Botox itself is receiving new scrutiny. The FDA recently agreed to review its safety after finding that 180 people treated for medical – not cosmetic – conditions developed respiratory problems after injections. Sixteen people have died, including four children.

The issue came to the fore in January after Public Citizen, a consumer watchdog group, reviewed data submitted by manufacturers to the FDA. Public Citizen has petitioned the FDA to require a more prominent warning label, indicating that in rare instances, the active ingredient, botulinum toxin types A and B, can travel from the injection site to weaken muscles that affect breathing. It also wants the FDA to require that the manufacturers send warning letters to doctors who use Botox and Myobloc and that doctors distribute written warnings to patients.

“Every doctor who is injecting botulinum toxin needs to know about the dangers of the toxin spreading to other parts of the body,” said Dr. Sidney Wolfe, director of the Health Research Group at Public Citizen. “Every patient needs to know about these risks, and the only way this is going to happen is if doctors are required to hand patients a written warning every time they receive an injection.”

If those requirements are set, then patients will know to pay attention to early symptoms and seek help before they become serious, Wolfe said.

High doses

With millions of people receiving Botox or Myobloc injections, Delia said Botox already is one of the most extensively studied medications.

“You shouldn’t sensationalize it, nor should you trivialize it,” Delia said. “Botox is one of the most studied medications by the FDA, and it’s very safe if used appropriately.”

As a plastic surgeon, Delia uses Botox only for facial lines and wrinkles, particularly around the eyes and forehead, not for medical conditions. Other doctors use Botox successfully to treat neck and eyelid spasms, excessive sweating, and spastic limb movements, especially for children with cerebral palsy. When Botox is used for medical conditions, the dosage is much higher than for cosmetic procedures. The FDA is investigating whether a link exists between high doses and respiratory problems.

Delia believes problems can occur with Botox if the dose is too large or injected too deeply, especially in the neck area.

“If you go too deep, you can affect the esophagus and cause muscle weakness and you could have difficulty swallowing,” he said. “You have to be careful and know how much and how deep to go.”